The Medical Detectives Volume I

by Berton Roueche

  Because of the potential danger to humans of ingesting meat contaminated with methyl mercury (all three children are comatose and in critical condition), as well as the likelihood that the practice of feeding treated grain may be widespread among indigents raising livestock in the state, this matter is being brought to your attention. The possibility of methyl-mercury poisoning should be considered in any outbreak of... unusual central-nervous-system illness. Please notify the Preventive Medicine Section (Phone 505-827-2475) of any such occurrence, and we in turn will be happy to provide technical advice and assistance:

  The letters were mailed out on Thursday, January 22. The Preventive Medicine Section spent Friday and the weekend waiting for the ring of the telephone and the urgent voice of a doctor. But nothing happened. Nothing happened the following week. February loomed, and began. Still nothing. The Preventive Medicine Section sat back and relaxed. They let themselves assume— correctly, as it turned out—that the outbreak was confined to the Huckleby family.

  Nevertheless—as it also turned out—the danger of an epidemic had been real. Early in February, the results of the hog examinations were announced. The first report was on the embargoed packing-plant carcasses. It seemed to justify Mr. Lancaster's investigatory zeal, but its meaning was otherwise not entirely clear. Of the two hundred forty-eight carcasses examined by the Department of Agriculture, one—just one—was found to contain a high concentration of mercury. The others, curiously, were uncontaminated. The contaminated carcass was ordered destroyed, and the others were released to the market. The Toxicology Laboratory's report on the hogs taken from the Alamogordo pens was very different. Six hogs were examined, and all six were found to be dangerously contaminated with mercury. This unequivocal finding condemned the remaining hogs in the pens, and the state issued an order for their destruction.

  Dr. Likosky returned to Atlanta with the Huckleby outbreak still very much on his mind. What particularly disturbed him was its implications. This led him back to the library and he undertook a comprehensive exploration of the literature on organic mercury compounds and organic mercurialism. It was not a reassuring experience. Mercury fungicides, he learned, were developed in Germany around 1914 and came into almost universal use shortly after the First World War. He learned that the Minamata episode was not the only outbreak of organic-mercury poisoning caused by contaminated fish. It was merely the first. In 1965, despite the morbid Minamata example, a similar outbreak occurred on the Japanese island of Honshu. A total of a hundred twenty people were stricken there, and five of them died. He learned that the Guatemalan episode was not the only instance on record of poisoning caused by eating treated grain. A similar outbreak occurred in Iraq in 1961, and another in Pakistan in 1963. A total of almost five hundred people were struck down in the three outbreaks, and the mortality rate was high. He learned that the Huckleby hogs were not the first American hogs to be stricken with chronic mercury poisoning. They were merely the first involved in human mercurialism. He learned that on February 1, 1966, Sweden had revoked the license for the use of certain highly toxic mercury compounds (including methyl mercury) in agriculture. He learned that the 1969 pheasant-hunting season in the Canadian province of Alberta had been canceled after a survey of the pheasant population showed an average mercury level of one part per million— a hazardous concentration. And, closer to home, he learned that a similar survey in Montana that same year revealed a level of mercury contamination that prompted the State Game Commission to advise hunters against eating the birds they shot. In both instances, the pheasants had been exposed in the field to treated seed Dr. Likosky arose from his reading with a sense of apprehension. He sought out two of his colleagues, Dr. Hinman and Mr. Barthel, chief of the Toxicology Branch, and found that they shared his concern about the proliferating casual use of a substance as toxic as methyl mercury. They also felt that a broader discussion of the matter was desirable, and Mr. Barthel arranged for a meeting in Washington with interested representatives of the Department of Agriculture and of the Food and Drug Administration. At the meeting, which was held on February 12, Dr. Likosky, Dr. Hinman, and Mr. Barthel reviewed the Huckleby case and its varied antecedents, and suggested that they constituted a looming public-health problem. Their arguments were well received, and on February 19 the Department of Agriculture issued a statement on the subject. It read:

  The U.S. Department of Agriculture has notified pesticide manufacturers that Federal registrations are suspended for products containing cyano methyl mercury guanidine that are labeled for use as seed treatments.

  U.S.D.A.'s Agricultural Research Service suspended cyano methyl mercury guanidine fungicide because its continued use on seeds would constitute an imminent hazard to the public health. Directions for proper use and caution statements on labels of the product have failed to prevent its misuse as a livestock feed. The U.S.D. A.-registered label specifically warns against use of mercury- treated seed for food or feed purposes. The pesticide may cause irreversible damage to both animals and man.

  The action was taken following the hospitalization of three New Mexico children after they ate meat from a hog which had been fed seed grain treated with the now-suspended mercury compound. Subsequently, 12 of the remaining 14 hogs also fed the seed died.

  "Other movements of this treated seed that found its way into livestock feed posed a potential for similar incidents," Dr. Harry W. Hays, director of the Pesticides Regulations Division, USDA- ARS, said in announcing the suspension action. "In each case, USDA and state public health officials have taken prompt action to protect the public health." Dr. Hays also announced that the ARS had asked the Advisory Center on Toxicology of the National Research Council to review the uses of other organic-mercury compounds to determine whether similar hazards to human health existed in connection with the use of these compounds.

  March came on. Ernestine and Amos Charles Huckleby were discharged from Providence Memorial Hospital, in El Paso, and transferred to the chronic-care facility of a hospital in Alamo-gordo. They were still comatose. (Ernestine will probably be permanently comatose. She is almost certainly blind. Amos can communicate on a primitive level. He, too is blind.) At the same time, Dorothy Huckleby was removed to a rehabilitation hospital in Roswell. (It is expected that she may in time recover enough to care for herself under general supervision.) Meanwhile, Mrs. Huckleby's term approached. Because of the delicate nature of her pregnancy, state health officials had recommended that her confinement take place in the scientifically sophisticated environment of the University of New Mexico Medical Center, in Albuquerque, and she was admitted to a maternity ward there. Her condition was satisfactory and her course was uneventful. On Monday, March 9, she was delivered of a seven-pound boy. At birth, the baby appeared to be physically normal, but a few hours later he experienced a violent convulsion. He survived the seizure, and recovered. The prognosis, however, was uncertain. It is very possible, in view of his long fetal exposure to mercury, that some physical or mental abnormalities will eventually manifest themselves.

  April arrived. Manufacturers affected by the federal suspension order on seed dressings containing cyano methyl mercury guanidine stirred, and suddenly struck. On April 10, Morton International, Inc., and its subsidiary Nor-Am Agricultural Products, Inc., the makers of Panogen, applied in United States District Court in Chicago for an injunction relieving the company of compliance with the suspension order, and the application was granted by Judge Alexander J. Napoli. The grounds for granting the in junction were that the Department of Agriculture had acted Without holding a hearing to establish the hazardous nature of the fungicide.

  The government appealed, and on July 15 a three-judge panel of the Court of Appeals turned the government down, again citing insufficient evidence. The government then petitioned for a review by all six judges of the Court of Appeals. This request was granted, and the full panel met and reviewed the case. Their decision was announced on November 9. The panel ruled, by a vote of f
our to two, to uphold the government suspension. Thus, after almost seven months of swinging in the wind of legal technicalities, the door was closed again on methyl mercury guanidine dressings, and this time firmly latched.

  [1970]

  CHAPTER 16

  All I Could Do Was Stand in the Woods

  Adolph (Rudy) Coniglio says his trouble began on the night of July 27, 1969, a Sunday. He was then fifty-three years old and the proprietor of a restaurant called Rudy's Pizza, in Closter, New Jersey. He remembers:

  "Two of my people, the cleaners, they didn't show up that night to clean. So I stayed after closing and did the cleaning myself. I did the kitchen, the counter, the dining room, where I got twenty tables—I did it all. So I perspire even in that air-conditioned place, and I got so hot that I didn't sleep good all night. So I got up the next morning with this heavy cold and fever. I don't feel good. So my wife goes down to run the place, and I went over to this doctor —this local, family doctor—and he prescribed some yellow antibiotic pills. I took those pills and stayed three days at home. On Thursday, I went back to the restaurant. I got there early, and I felt all right. Not bad. So I start to work in the window up front and make some pizza dough. Pizza is my specialty, I make it all myself. O.K. Well, now the dough is rising good, so I get out some tomatoes and the other stuff for a pizza alia napoletana. All of a sudden, I start to smell something funny. Something bad I'm peeling a tomato, and I smell it. It smells rotten. It smells like garbage. Then I taste it. It has the taste of garbage. I call the wholesaler, and I'm mad. What's the matter, you send me rotten tomatoes? He says I'm crazy—he don't handle rotten tomatoes. Now he's mad. I hang up and go out to the kitchen to find some good tomatoes. But—oh, my God! Did you ever when you're a kid burn a plastic comb? Everything in the kitchen smelled like that I had to get out. I went back to the front, and it was just as bad. That smell—that garbage stink. Some of my people were coming in, and I told them, but they don't smell nothing. So it must be me. It must be that heavy cold.

  "I figure I'm still sick. So I got my car and went home. The street was almost as bad as the place—the exhaust fumes. It was the same stink. It was better at home. Some. But not much. My wife went down to the restaurant again. I went outdoors, out in the back yard. It was better there than in the house, but it had a smell. The grass had a smell. It smelled like regular grass—only twenty times stronger than normal. It smelled so strong it smelled bad. I got some woods behind my house, so I tried there. That was better. It was O.K. I tell you, it felt good to get away from that garbage stink. I sat down on a log, and it was nice sitting there, so after a while I lit a cigarette. Oh, my God! The smell was like everything else—and the taste! It burned on my tongue like a hot pepper. So I don't have anything to do but just sit in the woods. I stayed there all day. When it was time for dinner, I couldn't eat. Everything had that stink. I thought I might as well go to bed. I got ready and laid down, but I had to sit up. The pillow—it smelled like dirt. So my wife went out to the store and bought a new pillow. It had a smell, but it wasn't too much. But I had to sleep on my back. I couldn't have my face in the pillow. So the next day I went back to the doctor.

  "The doctor was surprised. But he thought like me—it was still that cold, that flu I had. He gave me a new prescription, for some pink antibiotic pills, and said to come back in a couple days. But the pills didn't help. I went back to the doctor. He told me to wait a while. Be patient. So I had to hire somebody to run my place. All I could do was stand in the woods all day. Of course, I had to eat—I didn't want to die. But the regular food—it was all like garbage. I could drink a little cold milk. I could eat a little cold boiled potato. I could eat a white grape. I could eat a little vanilla ice cream. That stuff, it didn't taste good, but it didn't taste bad. It didn't have any taste at all. So I lived on that. No coffee—God forbid. Even a banana—I couldn't go near it. I went back to the doctor again, and he sent me to another doctor—an ear-nose-and- throat man. A specialist. He looked at my nose and he took some X-rays, but he couldn't find anything wrong. He called the family doctor and said, This Rudy, what he needs is psychiatry, his trouble is psychosomatic. He sent me to a psychiatrist. So the psychiatrist started talking about my life history—did I like my work? My God, I love my work. I listened and I went out and I didn't go back. Well, now it was almost September. I wasn't any better, I was losing weight, and the only time I was comfortable was out in the woods. So I decided to go to Italy. My mother is there, and I thought maybe the Italian doctors could help me. I went to Naples and saw a doctor there, and I went to a doctor in Rome. But they were the same as at home. It was all in my mind. Did I like my work? They gave me some tranquillizer pills. Five a day. Ten a day. I stayed a month and came back home in October.

  "By this time, I don't know what to think. Am I crazy? Maybe those doctors they're right. They keep saying it's my mind. Or maybe they're making me crazy. I try another doctor. Not in Closter—in another Jersey town. This doctor looks at my nose with a needle, and a little blood comes out. Ah, he says, I know what you got. You need an operation. So he gives me a date. But I don't take his word. I go to another doctor next day. He says he first wants X-rays. But I just had X-rays yesterday. He wants to know who, and I tell him, and he calls that doctor and they talk. Then he looks at my nose again, and he finds where that needle touched me. Ah, he says—that's it. You got a tumor. Very serious. Operate at once. But I went home. I thought I was going to drop dead. Then I thought I better kill myself. I've lost forty pounds of weight and I've spent a hell of a lot of money, and now I've got a tumor in my nose. But, thank God, I've got a neighbor friend. His job is hospital administrator at a big hospital in New York, in Manhattan. I talk with him sometimes, and so one day this is maybe December—he says, Maybe you better try my hospital He says they've got good men, and so he arranges everything and I get a date. So I walk in the hospital and they're waiting for me—three doctors. Everything is organized right. But first another X-ray. O.K. And then—my God, good news. The head doctor says no tumor. They don't find anything. But the head doctor is interested. He says he wants to see me in his office. He's got a private office up around Fifty-seventh Street, and I went there the next day. We visited and talked for an hour. He couldn't find whirl was wrong. He ordered me again some pills, and a spray for my nose. He says to come back in a couple days so he can see the reaction. But he don't find any reaction. No better. No change. So then I tell him what I'm worried about. I say, Listen, Doctor they send me to all these psychiatrists, and they talk about psychosomatic. I say, I'm willing to go to the crazy house. I don't care anymore. I had enough. But I want to ask one thing. Do crazy people have their food taste like garbage? And the doctor says no. He says they eat like everybody else. He says, I don't know the trouble with you, but I know one thing. You're not crazy.

  "That made me feel better, so I was ready to go. But he said wait a minute. He said he couldn't help me but he thought he knew a man that could. He said there was a doctor down in Washington, a specialist at the National Institutes of Health, that was coming up to New York pretty soon. He wanted me to see him. So I went home and waited. At least I wasn't crazy. But I still can't eat or smoke or work or do anything but go out and stand in the woods. It's Christmastime, and I'm living like a dog. Well, I wait a couple weeks, then I get the call. There's a Dr. Gould, with an office on Seventy-seventh Street, and this man from Washington is waiting for me there. So I go over and meet him—Dr. Henkin, of the National Institutes of Health. He takes me into a little room. I talk and he listens. Then he says, Open your mouth. So I open. Stick your tongue out. So I do, and he puts a drop of something on my tongue. He says, 'How does it taste?' I tell him, 'No taste at all.' 'Good, he says—now I know what you got. But I can't treat you here. You got to come down to the Institutes of Health.' My God, I didn't know it then, but there was a god. That's all I can say about Dr. Henkin. He's a god."

  Dr. Henkin is Dr. Robert I. Henkin. He was at that time
chief of the Section of Neuroendocrinology, Experimental Therapeutics Branch, of the National Heart and Lung Institute of the National Institutes of Health, in Bethesda, Maryland, an appointment he had held since July of 1969. Since 1975, he has been director of the Center for Molecular Nutrition and Sensory Disorders at the Georgetown University Medical Center, in Washington. He says: "Well, I thought I knew what Rudy's trouble was. I thought he had what we call idiopathic hypogeusia. It's a condition that involves a loss of taste acuity—the ability to distinguish tastes— and it is often accompanied by a distortion of taste and smell. The cause is unknown, or idiopathic. The reason I suspected it in Rudy was simply that I had it on my mind. I had seen the same condition twice before—and only a few weeks earlier. Aberrations of taste and smell are not, of course, at all unusual. They are common symptoms of the common cold. And hepatitis. And pregnancy. But my introduction to idiopathic hypogeusia was entirely accidental. I had occasion to mention the loss of taste acuity, with a related distortion of taste and smell, in a refresher training course in the basic sciences that I was teaching at the Armed Forces Institute of Pathology in the fall of 1969. It was sometime in early September. Well, about a month later I got a call from one of the officers who had taken the course—an Air Force colonel down in Texas. He had a patient at his base he thought I might want to see. Sergeant Mack, I'll call him. Mack's complaint was pretty much what I had been talking about. Everything he ate or drank smelled and tasted foul. But he didn't have a cold, he didn't have hepatitis—he seemed in every other respect to be in normal good health. I said I was very much interested. I said to send him right up.